Health Chairs at the Helm: Changing the Way We Do Business National Conference of State Legislators

Transcription

1 Health Chairs at the Helm: Changing the Way We Do Business National Conference of State Legislators Life Beyond Treatment: Focusing on Recovery Connecticut: Innovation in Recovery-Oriented Systems of Care (ROSC( ROSC s) Peggy Sayers, Chair, Public Health Committee Ronald Fleming, Service Provider Thomas A. Kirk, Jr., State Agency Phillip Valentine, Recovery Community June 20, 2008 Washington, D.C.

2 Goals of Session Recovery-Oriented System of Care (ROSC) Why do It? It? What is It? It? How do you create It? It? Benefits of ROSC Person, Provider, Funder? Challenges to a fully functioning ROSC Opportunities where do we go from here?

3 DMHAS We are a healthcare service agency. Promote health Recover and sustain health through prevention and early intervention services. through treatment and recovery support services. Need to broaden and strengthen our system of effective prevention, early intervention and treatment services.

4 Why Move SYSTEM to Recovery- Oriented Model? System-perpetuated stigma Acute care service is often wrong model Disproportionate funding allocations Customers vote with their feet Less than meaningful outcome measures Weak message to funder & policy makers Perception that System is irrelevant and/or doesn t t work in larger context

5 Doesn t Anybody Ever Get Better? What message are we conveying? addicts a chronic, relapsing disease severe persistent mental illness

6 Substance Use Disorder As Too Often Viewed By The Funder And/Or Service Provider Severe 100 Symptoms Person s Entry into treatment Discharge Remission0 Time

7 Severe 100 Substance Use Disorder Typical service response? Yes, too often Symptoms Remission0 Acute symptoms Time Discontinuous treatment Crisis management

8 Helping People Move into their Recovery Zone Severe 100 Recovery Zone Symptoms Remission0 Improved client outcomes Time

9 Many Paths to Recovery

10 Take What You Need and Leave the Rest Don t t keep such an open mind that your brains fall out Recovery is a process of thawing out frozen feelings An alcoholic is an egomaniac with an inferiority complex Turn scars into stars Bring the body and the mind will follow Change your playmates, playthings and playgrounds Tragedy plus time equals humor Honesty without compassion is brutality Feed your faith, starve your fear

11 Voices of Recovery Having hope Getting well/getting better Having same rights as others Making choices Doing everyday things Making changes, having goals Staying clean and sober Starting over again Be looked at as whole people Looking forward to life

12 What Is Recovery? REFERS TO THE WAYS IN WHICH A PERSON WITH A SUBSTANCE USE DISORDER AND/OR MENTAL ILLNESS EXPERIENCES AND MANAGES HIS OR HER CONDITION(S) IN THE PROCESS OF RECLAIMING OR REBUILDING HIS OR HER LIFE IN THE COMMUNITY. AT ITS CORE, IT IS THE RESTORATION OF SELF-ESTEEM, ESTEEM, POSITIVE IDENTITY, A MEANINGFUL ROLE IN SOCIETY AND, TO THE MAXIMUM EXTENT POSSIBLE, INDEPENDENT LIVING

13 Recovery Oriented System of Care? It consists of any and all the tools that a person can choose to use to keep them in the recovery zone and that sustain their long term recovery It includes the tools the funder financially supports and evaluates, the tools the service provider offers in his/her service menu, those the person identifies and that work for him/her to build up their recovery capital, and those tools that come within the recovery community that tap into the inherent nature to give back

14 Life Beyond Treatment: Focusing on Recovery Benefits of Recovery-Oriented System of Care Supports & strengthens conventional services Wrap-around services Continuum of care Peer supports & involvement

15 Life Beyond Treatment: Focusing on Recovery Benefits of Recovery-Oriented System of Care Promotes client integration within the community Peer networks as a component of integration Involvement of non-traditional groups The role of giving back

16 Life Beyond Treatment: Focusing on Recovery Benefits of Recovery-Oriented System of Care Stronger networks Enhanced Recovery Capital Reduces relapse risk Improves early intervention when necessary Enhanced resiliency Enhanced confidence Reduced stigma

17 CCAR, a Recovery Community Organization Recovery Community Treatment Community bridges the gap

18 What Do You Think? Comments? Questions? Make sense? OK to go on?

19 Recovery, Recovery-Oriented System of Care MAJOR IMPLICATIONS FOR: CONTENT DELIVERY FINANCING OUTCOMES

20 What People Want from Healthcare System A welcoming healthcare setting, prompt access An expectation of getting better, not necessarily cured Hopeful, respectful atmosphere Tx and tools for the person to manage/own their recovery ( you( can do it; we can help ) Show me somebody it worked for Have a life again be renewed

21 Recovery Core Values Developed by CCAR & Advocacy Unlimited, 1999 Participation Participation No wrong door Entry at any time Choice is respected Right to participate Person defines goals Funding-Operations No outcomes, no income Person selects provider Protection from undue influence Providers don't oversee themselves Providers compete for business Programming Individually tailored care Culturally competent care Staff know resources

22 Recovery Core Values Direction Equal opportunity for wellness Recovery encompasses all phases of care Entire systems to support recovery Input at every level Recovery-based outcome measures New nomenclature System wide training culturally diverse, relevant and competent services Consumers review funding Commitment to Peer Support and to Consumer-Operated services Participation on Boards, Committees, and other decision- making bodies Financial support for consumer involvement

23 Commissioner s s Policy #83: Promoting a Recovery-Oriented Service System (2002) Provides recovery vision for the system Establishes recovery and quality as overarching system goals Recovery a process, not an event Emphasizes person centered, strength approach Guides policy and planning efforts Encourage hope and emphasize respect Highlights importance of meaningful community membership

24 Policy Continued Embed the language, spirit and culture of recovery throughout the system of services, in our interactions with one another and with those persons and families who entrust us with their care Being Reviewed and Updated by Multi- stakeholder group, Due July 2008

25 The pursuit of meaningful community life must be at the heart of the care and planning process throughout! work or school Selfhelp faith treatment & rehabilitation housing A person-centered system of care supports the person s efforts in managing his or her condition while s/he is regaining or establishing a whole life and a meaningful sense of membership in the broader community. social support family WHILE not AFTER! belonging

26 What Funder Wants Satisfied customers, customers, get better Person centered vs. agency centered care Good brand recognition An effective care system with face validity Outcomes understandable to their funders Flexible, innovative and dynamic system High Value = Quality/Cost

27 Funder? What else? Maximize existing service capacity Identify savings from repeated crisis and acute care services with limited sustained benefit Learn & draw from the recovery and provider communities Maintain data tracking-decision system Reinvest savings into recovery support and clinical services that promote sustained stability in recovery zone Recognize providers with high Value services

28 The Fiscal Realities Of ? 2010?

29 You need a little love in your life and some food in your stomach before you can hold still for some damn fool s lecture about how to behave Billie Holiday

30 Recovery Support Services Housing: Sober Housing, Recovery House, Independent Transportation Peer service to & from some treatment setting, bus tokens Case Management Recovery Guides, Coaches, Peers Employment services (from DOL certified employment provider) Basic needs (food, clothing, personal care items, utilities, etc.) Faith supports (individual mentoring/coaching and groups) Peer supports ( same as above) Recovery clinical checkups Telephonic recovery support calls

31 Recovery Support Services (CCAR) All-Recovery Recovery Groups Recovery Training Series Family Support Groups Recovery Coaching Recovery Social Events Telephone Recovery Support* Recovery Housing Project*

32 Recovery Community Centers Field of Dreams build it and they will come

33 Recovery Community Centers a recovery oriented sanctuary anchored in the heart of the community a physical location where CCAR can organize the local recovery community s s ability to care a place where Recovery Support Services are delivered services are designed, tailored and delivered by local recovery communities Volunteer Management System including people in long-term, sustained recovery

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35 Does CCAR Make A Difference? In 2007 More than 15,000 people walked through the doors of our 4 Recovery Community Centers seeking some type of recovery support or assistance 304 Volunteers contributed more than 10,000 hours of service Telephone Recovery Support reached 500 individuals with Volunteers making more than 7,400 outbound calls CCAR fielded more than 1,500 requests for recovery housing beds CCAR held 70 trainings for 576 participants on topics like the Pardons Process, Understanding Addiction and Recovery, Racism of the Well-Intended, Money management, etc.

36 Sample Recovery Support (RS) Outcomes CT Access To Recovery Effective outreach, 40% of 18,000 had no previous contact with DMHAS care system GABHP 68% Connect to care post inpatient for those with RSS vs 38% without RSS Urban Initiative (housing) 600% Decrease in ER visits, 375% decrease in detox days RS 93% of 4,036 still in recovery one year later Recovery House 69% Connect to care vs. 36% without Recovery House stay Supportive housing 61% decrease in inpatient costs

37 Does CCAR Make A Difference? From GPRA data over the last 3 years, after 6 months 92.2% are still drug and alcohol free 99.1% have successfully addressed their legal issues and remain crime free 73.1% found jobs and/or went back to school 82.9% found safe and affordable housing 99.4% are reconnected with their family, friends and community Participants have significantly reduced their health risks for HIV and other drug-related related health problems from 77% when they first participated in the program to 55% six months later reflecting reflecting a 22% drop

38 Telephone Recovery Support In the spirit of KISS, a new recoveree would receive a phone call from a trained volunteer (usually another person in recovery) once a week for 12 weeks Volunteer follows script Low cost, win/win scenario CCAR gives new recoveree a better shot at maintaining their recovery AND helps the Volunteer making the call Provider helps their clientele Prior to discharge, provider offers recoveree the telephone support program. Results, outcomes, evaluations all outstanding

39 Telephone Recovery Support When asked if I find the TRS (Telephone Recovery Support) calls helpful I can t t say yes enough. There s something so supportive about knowing that no matter what happens in my life there s s someone who genuinely cares about how my recovery is going. My volunteer has shared in every victory I have had in my recovery since the calls began. I hope to continue receiving these calls for a long time to come. ~Constance Carpenter, recoveree enrolled in CCAR s s TRS program for the last 55 weeks

40 Telephone Recovery Support Out of all of the commitments I ve I had TRS is my favorite way of giving back. Honestly it s s a toss up as to who gets more out of it me or them. ~Caroline Miclette, TRS Volunteer When I was using my phone never rang and I wanted it to. I remember just sitting there, staring at the phone wishing someone would call me, talk to me possibly help me. Now I m I m in recovery, for me this is the perfect way of giving back being that phone call that I never got. ~Curtiss Kolodney, TRS Volunteer

41 Recovery Housing Project Inventory existing recovery housing (independently owned, privately operated sober houses ) One of a Kind database Establish the Recovery Housing Coalition of Connecticut Standards Advocacy Monthly meetings Deliver So, You Want to Open a Recovery House? trainings

42 Still with us? Comments? Questions? Make sense? OK to go on?

43 Some System Change Tools Policies set a tone Values Recovery Community Core Values Infrastructure Data system, Automated Recovery Plan,, Home-grown Public Sector Managed Care Approach Practice Requirements/Guides Provider Annual Recovery Assessment & Plan, Recovery-Oriented Practice Guidelines, Contract Language Outcomes Pilot Measures, Consumer Survey Finance Strategy Savings and Reinvest Model

44 Setting the Tone Through Policy Commissioner s Policy Statement #33, Individualized Recovery Planning, March 27, 2007 The Plan of care shall be developed in collaboration with the person with provisions to ensure that they have the opportunity to play an active, meaningful role in the decision-making process. Focusing solely on deficits in the absence of a thoughtful analysis of strengths leads to disregarding the most critical resources an individual has on which to build on his or her efforts to advance in his or her unique recovery journey. The primary focus of recovery planning is on what services the person desires and needs in order to establish and maintain a healthy and safe life in the community Given this community focus, one tool required is an adequate knowledge of the person s local community and its opportunities, resources, and potential barriers.

45 Person Centered Recovery Plan Promotes self-determination and community membership in valued social roles Re-orients orients participants, including providers to strengths based or solution oriented models Develops skillful use of personal and community assets Extends beyond medical model

46 Lesson Learned Necessity of Clear Expectations and Guidelines Provider Recovery Self-Assessment Consumer survey and language required by contracts Recovery-oriented oriented performance measures Recovery-Oriented Practice Guidelines Primacy of participation Community mapping and development Promoting Access and engagement Identifying and addressing barriers to recovery Ensuring Continuity of care Functioning as a recovery guide Employing Strength-based Offering Individualized recovery assessments planning

47 Financing Strategies SAVINGS REINVESTMENT - Use acute care savings from existing Fee for Service funding for new admissions into existing service capacity, support new clinical levels of care, e.g., intensive outpatient co-occurring occurring care or for recovery support services, e.g. Recovery Houses, Recovery Checkups, Peer Coaches EXTERNAL, FEDERAL AND OTHER GRANTS Funds research and development. Use lessons learned and funds to reframe existing funding allocations & services FUNDING PARTNERSHIPS criminal justice and child welfare systems, private non-profits, academic communities, person in recovery community

48 Specialized Intensive Supports ASO identifies people with 3 or more acute hospital admissions within 90 days Recovery manager initiates contact while person is still in hospital Recovery plan developed to fill support gaps Recovery manager helps with transition to community care Recovery Recovery Zone Zone # of Episodes % reduction in acute care episodes! 6 Mos. Before 6 Mos. After

49 Value-driven Strategy Improved Care, Better Value OATP 4/01 now (2000+ cases) OATP (Opioid Agonist Treatment Protocol) Connecticut s program of alternative treatment opportunities for opiate-addicted persons who use residential detoxification programs over and over. M otivational Interv iew ing Cultural Com petence Identification Education/Information Access Opioid Agonist Treatment Ancillary Treatment Support Services Service Coordination Traum a Co-occurring Disorders Recovery

50 OATP Client Participants (2,000+ since April 2001) OATP Eligible Client count

51 Better Care, Resource Management Acute Care Claims Expense for OATP clients $4,000, $3,500, $3,000, $2,500, $2,000, $1,500, $1,000, $500, $

52 OATP Pre-Post Post Admission Analysis Comparison of Annual Average #Admissions - 6 months before & 6 months after OATP Initiation End 9/30/04 End 9/30/05 End 9/30/06 End 9/30/07 6 Mos Prior Mos After

53 Reallocation of Resources through Intensive Case Management (Recovery Specialists) N= 2185 Clients 5,000 Paid Episodes 12 months Before & 12 months After GA ICM A ssignment (by 2/28/07) 4,000 3,000 2,000 1,000 0 Inpt & Res Detox Inpt MH Inten Res Long Term Res Respite/ Obs Bed PHP IOP OP Ambi Detox MethMaint/ MethDetox BEFORE 4,644 1, AFTER 1,441 1, ,274 1,

54 Cutting Treatment Drop-Out by More Than Half 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Comparison of Treatment Dropout Rates GA ICM vs. Non-GAICM Feb-06 Feb-07 Feb-08 GAICM HU 7.14% 3.42% 4.44% NON-GAICM HU 10.34% 9.77% 12.47% SAGA w/o CM 25.39% 26.80% 23.38%

55 Sample Specialized Continuing Care, Long Term Recovery Management Service System Outcome Measures Overall Rate of Growth of Costs Percent of total costs for each Level of Care (LOC) Access, Retention and Drop out indices Percent of Total Client Admissions into Each LOC Percent of First Time Admissions within Existing System Capacity Pre/Post Recovery Support Service Cost and Service Comparisons Rate of Connecting to Lower Level of Care (LOC) 7, 14, 30, 90 days from acute care episode Rate of Readmissions to Same or a Higher Level of Acute Care within x Days of Discharge from a Detox,, Inpatient or Acute Care Service Consumer Survey Results: Access, Appropriateness, General Satisfaction, action, Outcomes, Recovery, Participation in Tx,, Respect

56 Life Beyond Treatment: Focusing on Recovery Impediments and challenges to advance to a fully functioning recovery oriented system of care Services Funding Design Workforce Issues Service Stream Regulatory Environment

57 Life Beyond Treatment: Focusing on Recovery Services - Funding Design Discourages efficiency & reserve building Episode of care driven models [units of service] Insufficient funding Unpredictable funding

58 Life Beyond Treatment: Focusing on Recovery Workforce Issues Shortages of appropriate candidates Shortages of minority candidates Shortages of licenses or certified candidates Training needs for inadequately prepared employees Escalating expectations for staff performance Low salaries competition from state operated

59 Life Beyond Treatment: Focusing on Recovery Regulatory Environment Staff level regulation Service level regulation Inflexibility Lack of Coordination Unpredictable enforcement

60 Challenges Along The Way Redesigning in mid air Client Empowerment Staff Reaction Hit the Wall the plateaus I ve been wrong all these years Advocacy Chasing Windmills Too Complicated Project Du Jour. And I ll I Be Out of Business Buy in Staff you never asked me Who made you recovery champion?

61 Challenges/Opportunities New partnerships for employment, economic development, community asset mapping Wellness rather than disease and disability A larger choir for the field Our field is truly RELEVANT People are respected, have hope, recovery, renewed lives

62 Policy, Operational Or Planning Challenges Define Episode of Care in new way, e.g., service bundles Design Bundled Combinations of Services and Rate Methodology Anticipate and Combat System Relapse due to State Fiscal Climate Don t t Focus so Much on Continued Care That Neglect Early Identification, Intervention and primary care linkages Talking about Spending Differently, Not Spending More or Less

63 Key Policy Issues/Questions Do you want bricks and mortar or people living in communities with natural supports? Should we focus on healthcare costs or on the cost of disability and disease? How do we widen and reinforce the Recovery Zone for people with disabilities? Should addiction be The Agenda or part of Every Agenda? Are we talking about spending more or less, or spending differently?

64 Take Home Messages Creating a continuing care, recovery oriented service system is a marathon and requires system changes at all levels it it s s like redesigning a plane in the air Maintaining a sense of urgency is essential for continuing care paradigm shift Non-traditional traditional or recovery-support services help people get better, must be matched with one s s individual path to recovery and are efficient and effective per p se and as ADJUNCTS to treatment Performance and outcome metrics for such a system, for state agency providers or funders, are not the traditional ones and require a well communicated cated healthcare business plan strategy

65 For such individuals, like Billie Holiday, it may not be a matter of more (e.g., detox, treatment, medication) but of something different that may be required to initiate, pursue, and maintain recovery

66 Contact Information Ronald Fleming, President and Chief Executive Officer Alcohol and Drug Recovery Center (ADRC), Hartford, Ct Thomas A. Kirk, Jr., Commissioner Ct. Dept of Mental Health & Addiction Services (DMHAS) Peggy Sayers, State Representative, Chair, Public Health Committee Connecticut General Assembly (CGA) Phillip Valentine, Executive Director Connecticut Community for Addiction Recovery (CCAR), Hartford, CT C phillip@ccar.us,, Website: (860)